Global health care facilities have been overloaded with highly infectious patients seeking testing and care as the COVID-19 pandemic accelerates. The successful use of PPE consisting of face masks, gloves, goggles, face shields, respirators, gowns, and air-purifying respirators is necessary to prevent the spread of infection to and from health care workers and patients. In areas of high demand, a crucial shortage of PPE kit is expected to grow. In many areas, PPE once disposed of in the hospital setting, is now a valuable product when it is most needed to care for highly infectious patients. Increasing the availability of PPE in response to this new demand would entail a significant increase in the output of PPE, a process that, considering the rapid spike in ill COVID-19 patients, would be too time-consuming for some health care systems.
The Centers for Disease Control and Prevention (CDC) defines three stages of operational status in its latest guidelines to optimize the use of face masks during the pandemic: conventional, contingency, and crisis.1 Face masks are used in traditional ways during normal times to protect healthcare workers from body fluids and sprays. When health care systems become overwhelmed and enter the infectious mode, by selectively canceling non-emergency procedures, postponing non-urgent outpatient experiences that may involve face masks, eliminating face masks from public areas, and, if possible, using face masks for prolonged periods, CDC advises conserving resources.
The CDC suggests canceling all non-urgent and elective procedures and outpatient appointments for which face masks are usually used when health systems reach crisis mode, using face masks beyond the prescribed shelf life during patient care operations, restricted reuse, and prioritizing use for activities or processes in which aerosolization or sprays are like In the absence of face masks, the CDC advises the use of face shields without masks, the withdrawal from clinical care of clinicians at high risk for complications of COVID-19, staffing services with convalescent HCWs potentially resistant to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and the use of handmade masks, probably from bandanas or scarves if appropriate.
Many societies are quickly entering crisis mode in the US and globally. Unconventional options for PPE in local hospitals are recorded by common news outlets, such as garbage bags and plastic water bottle cutouts. Plans for resupply through the reuse of industrial capacity and other means are welcome, but it seems unlikely that the shortage can be addressed fast enough as supply chains become more dysfunctional in the pandemic.
An emergency-room doctor in New York City said they are in danger now. She pointed to the shortage of available kits in the USA for testing. More than 270,000 people have been vigorously screened by South Korea, a nation of 51 million. By contrast, only about 82,000 have been tested by the United States. She said the processing time for the very few samples she has on hand to obtain results is about three days.
Health-care staff also do not have access to the testing packages for celebrities and politicians that magically appear. They run out of the medical supplies they need to do their life-saving jobs.
There is a particularly acute shortage of personal protective equipment. N95 masks are meant to be used for medical personnel, which minimize their exposure for filtering out at least 95% of the particles in the air. But on Wednesday, after receiving concerns about widespread shortages, President Trump said his administration had requested 500 million of these masks. The CDC advised nurses to use bandanas as masks to cope with the burgeoning coronavirus epidemic. Immigration Enforcement agents have access to N95 respirators amid a nationwide pandemic as they arrest immigrants.
Several problems were at the root of the issue: a global surge in demand for protective gear that outstripped supply, a lack of adequate supplies in the Strategic National Stockpile, which is intended to supplement state and local supplies during public health emergencies, and a lack of federal coordination in response. As they struggled to outbid each other for sufficient supplies for the pandemic response, a national scrum for existing PPE ensued, healthcare systems, state governments, and individual healthcare centers against each other.
Many hospitals have a better supply of PPE 5 months later than they did in March and April. But with the drastic nationwide spike in cases of coronavirus that started in mid-June and shows no signs of slowing down, there are still questions about the availability of PPE.
And demand now comes not only from the hospitals that treat patients with COVID-19, but also from nursing homes, primary care physicians who want to maintain a healthy atmosphere when routine primary care patients continue to be welcomed back, and other frontline health care staff.
And some say the problem has never really gone away. Some hospitals perform better than others, but even in hospitals with a sufficient supply of PPE, many healthcare staff also have to reuse equipment that is meant to be used only once under normal circumstances.
To solve the problem, USPIRG supports legislation that would boost the production of domestic PPE and establish a central coordinator position within the government that would oversee the federal purchase and distribution of medical supplies and have the power to produce more equipment using the defense production act. Wellington says the bill will "block the gaping gaps" that exist in the medical supply chain, known as the Medical Supply Accountability and Distribution Act.